Inter-rater Intraclass Correlation Research Articles

Reliability of Two-Dimensional Video-Based Analysis in Adolescent Runners

Background:Running analysis is an essential component of evaluation of both injured runners and uninjured runners seeking advice on injury prevention. Reliability of two-dimensional (2D) video analysis has been reported in the adult running population. However, these findings may not apply to youth runners given their unique state during growth and development. The reliability of quantitative and qualitative video-based running gait analysis in the adolescent population is unknown.Purpose:The purpose of this study was to determine the intra-rater and inter-rater reliability of sagittal and frontal plane kinematics using 2D video analysis in healthy adolescent runners.Methods:High-definition videos were recorded of 10 healthy runners between 14-18 years old running on a treadmill at self-selected speed with markers attached to the thoracic spine, pelvis, and lower extremities. Kinematic variables in the sagittal and frontal planes were measured using Dartfish Motion Analysis Software™ (Fribourg, Switzerland) by three raters. Intra- and inter-rater reliability were calculated using Intraclass Correlation Coefficients (ICCs).Results:Of the 10 runners, 4 (40%) were male and the mean age was 16 ± 1.5 years. The intra-rater ICC for all kinematic variables ranged from 0.574 to 0.999 for the primary sports physical therapist, and 0.367 to 0.973 for the inexperienced research assistant. The inter-rater ICC for all raters ranged from -0.01 to 0.941. Eleven kinematic variables showed substantial agreement and 4 showed almost perfect agreement. Step width and foot progression showed fair and poor agreement, respectively.Conclusion:The results of this study demonstrate that a 2D video-based running analysis can be reliably performed in an adolescent population on all kinematic variables except for step width and foot progression. Inexperienced raters can be properly trained in the video analysis of running kinematics using Dartfish Software in order to consistently assess the same runner.

A purpose-design computational method for estimation of plane of maximum curvature in Adolescent Idiopathic Scoliosis.

Adolescent idiopathic scoliosis (AIS) is a complex three-dimensional (3D) deformity, and the plane of maximum curvature (PMC) is proposed to reflect these clinical features, which refers to a vertical plane presenting the maximum projected spinal curvature and its parameters include the PMC Cobb and orientation (angle between PMC and sagittal planes). This study aimed to develop a computational method (CM) for PMC estimation. Twenty-nine patients with AIS and computed tomography (CT) images were recruited. For CT, PMC was determined by rotating a vertical plane about its vertical axis with 5°increment until the maximum Cobb angle was measured. For CM, PMC was estimated via identifying the eight points (the corner points of the superior and inferior endplates of the upper and lower end-vertebrae respectively) in the coronal and lateral CT images. Two experienced raters repeated the PMC estimation three times with one-week interval. The intra-class correlation coefficient (ICC) and Bland-Altman method were used for statistical analysis. Twenty-seven right thoracic curves (RTs) (mean Cobb: 46.1°±12.4°) and 23 left thoracolumbar/lumbar (LTLs/LLs) (mean Cobb: 30.6°±11.1°) were analysed. The intra- and inter-rater ICC values were >0.91 and 0.84 in RTs and LTLs/LLs, respectively. The PMCs obtained from the CM and CT were showed good agreement was also observed between the PMCs obtained from the two methods according to ICC (>0.90) and Bland-Altman method assessments. This purpose-design computational method could provide reliable and valid estimation of PMCs for AIS, which has potential to be used as an alternative for 3D assessment.

Ultrasound Imaging Analysis of the Lumbar Multifidus Muscle Echo Intensity: Intra-Rater and Inter-Rater Reliability of a Novice and an Experienced Rater

Background and Objectives: Ultrasound echo intensity (EI) of the lumbar multifidus muscle (LMM) could offer valuable insights regarding muscle quality in people with low back pain (LBP). However, whether the rater’s experience noticeably influences the reliability and precision of LMM EI measurements has not been established. The aims of this study were to investigate the intra-rater and inter-rater reliability of LMM EI measurements, and to compare the reliability and SEM between a novice and an experienced rater. Materials and Methods: Twenty athletes (10 females, 10 males) with a history of LBP were included in this study. Transverse ultrasound images of LMM were taken at L5 in prone. LMM EI measurements were obtained bilaterally by tracing the maximum ROI representing the LMM cross-sectional area (CSA), avoiding the inclusion of bone or surrounding fascia. All measurements were performed by two novice raters and an experienced researcher. Each measurement was acquired by each rater three times for each side on three different images, and the average was used in the analyses. Raters were blinded to each other’s measurements and the participant’s clinical information. Intra-class correlation coefficients (ICCs) were obtained to assess the intra-rater and inter-rater reliability. Results: The intra-rater ICC values for the LMM measurements for the experienced rater were excellent (ICC all > 0.997). The inter-rater reliability ICC values showed moderate to excellent reliability (0.614 to 0.994) and agreement between the novice raters and the experienced rater, except for Novice 1 for the right LMM, which revealed lower ICCs and a wider 95% CI. Intra-rater and inter-rater reliability results were similar when separately looking at the right and left side of the muscle and participant gender. Conclusions: Our findings support the clinical use of ultrasound imaging for the assessment of LMM EI in individuals with LBP.

The Chinese version of OPTION scale: Is it reliable on measuring the shared decision-making among preoperative conversations

ObjectiveTo test the reliability of the Chinese version of the OPTION12 (OPTION12-C) scale; and to evaluate the level of shared decision-making (SDM) in the preoperative conversations for high-risk procedures by using the OPTION12-C. MethodsTwo hundred and ninety-seven conversations were rated. Cronbach's alpha, Pearson’s correlation coefficient and intraclass correlation coefficient (ICC) were used to assess the reliability of the OPTION12-C. Mean and median were applied to evaluate the scores. ResultsThe Cronbach's alpha was 0.603. The Pearson’s correlation coefficient of the sub-items ranged from 0.002 to 0.595; the inter-rater ICC was 0.992. The mean and median of the total scores were 9.61 ( ± 3.583) and 9 respectively. 430 family members appeared in the conversations. ConclusionThe reliability of the OPTION12-C was acceptable. The SDM behaviors of doctors were only scored at or close to the minimal skill level. High level of family involvement demonstrated the Chinese culture of family- centeredness. Practice implicationsThe OPTION12-C was proved to be applicable for testing the extent of SDM. The low level of SDM indicates a need to improve Chinese doctors’ communication skills.

Reproducibility and reliability analysis of the Luk Distal Radius and Ulna Classification for European patients with adolescent idiopathic scoliosis.

PurposeCurrent clinical and radiological methods of predicting a patient’s growth potential are limited in terms of practicality, accuracy and known to differ in different races. This information influences optimal timing of bracing and surgical intervention in adolescent idiopathic scoliosis (AIS). The Luk classification was developed to mitigate limitations of existing tools. Few reliability studies are available and are limited to certain geographical regions with varying results. This study was performed to analyze reproducibility and reliability of the Luk Distal Radius and Ulna Classification in European patients.MethodsThis is a radiological study of 50 randomly selected left hand and wrist radiographs of patients with AIS referred to a tertiary referral centre. They were assessed for bone maturity using the Luk Distal Radius and Ulna Classification. Assessment was performed twice by four examiners at an interval of one month. Statistical analysis was performed using the intraclass correlation (ICC) method to determine the reliabilities within and between the examiners.ResultsIn total, 50 radiographs (M:F = 13:37) with a mean age of 13.7 years (10 to 18) were assessed for reliability. The inter-rater ICC value was 0.918 for radius assessment and 0.939 for ulna assessment. The intra-rater ICC values for radius assessment ranged between 0.897 and 0.769 and between 0.948 and 0.786 for ulna assessment. There was near perfect correlation for both assessments.ConclusionThis study provides independent evidence that the Luk Distal Radius and Ulna Classification is a reliable tool for assessment of skeletal maturity for European patients. Minimal clinical experience is required to reliably utilize it.Level of evidenceIV

The evaluation of Rolimeter, KLT, KiRA and KT-1000 arthrometer in healthy individuals shows acceptable intra-rater but poor inter-rater reliability in the measurement of anterior tibial knee translation

PurposeTo assess measurement equivalence, inter- and intra-rater reliability, standard error of measurements (SEM) and false positive measurements (FPM) of four different knee arthrometers (KLT,Karl Storz; KiRA, I + ; KT-1000 MEDmetric Corp; Rolimeter, Aircast) in healthy patients.MethodsFour different investigators (two advanced (AR) and two beginners (BR)) examined 12 participants with healthy knees at two time points with regards to anterior tibial translation (ATT) and side-to-side difference (SSD). Test equivalence was assessed using the TOST (two-one-sided t test) procedure with ± 1 mm equivalence boundaries. Intraclass correlation coefficients (ICCs) were calculated using two-way mixed effects models. Furthermore, false positive-(SSD > 3 mm) and SEMs were assessed.ResultsA total of 2304 Lachman Tests were performed. Between-rater SSDs were equivalent between AR and BR raters for the Rolimeter only. Inter-rater ICC values (SSD, ATT) were graded as “poor” to “moderate” for all devices. Equivalent test–retest results were observed for all raters using the Rolimeter, KLT and KT-1000, whereas measurement consistency with KiRA was given in the advanced examiners group only. Intra-rater ICC values (Range: SSD, ATT) were graded as “poor” to “moderate” for SSD values and “moderate” to “good” for ATT. SEMs were lowest for the Rolimeter and highest for KiRA. FPM were never obtained with the Rolimeter (0%), twice (2.1%) with the KT-1000, three times (3.1%) with the KLT and 33 times (34.4%) using KiRA.ConclusionThere is acceptable intra-rater but poor inter-rater reliability with all tested arthrometers. Measures of knee laxity are comparable between Rolimeter, KLT and KT-1000 but higher for KiRA. Clinically, the present study shows that repeated arthrometry measurements should always be performed by the same investigators.

MRI Diffusion-Weighted Imaging to Measure Infarct Volume: Assessment of Manual Segmentation Variability.

Manual segmentation of infarct volume on follow-up MRI diffusion-weighted imaging (MRI-DWI) is considered the gold standard but is prone torater variability. We assess the variability of manual segmentations of MRI-DWI infarct volume. Consecutive patients (May 2018 to May 2019) with the anterior circulation stroke and endovascularly treated were enrolled. All patients underwent 24- to 32-hour follow-up MRI. Three users manually segmented DWI infarct volumes slice by slice twice. The reference standard of DWI infarct volume was generated by the STAPLE algorithm. Intra- and interrater reliability was evaluated using the intraclass correlation coefficient (ICC) by comparing manual segmentations with the reference standard. Spatial measurements were evaluated using metrics of the Dice similarity coefficient (DSC). Volumetric measurements were compared using the lesion volume. The dataset consisted of 44 patients, mean (SD) age was 70.1 years (±10.3), 43% were women, and median baseline NIHSS score was 16. Among three users, the mean DSC for MRI-DWI infarct volume segmentations ranged from 80.6%±11.7% to 88.6%±7.5%, and the mean absolute volume difference was 2.8±6.8 to 13.0±14.0 ml. Interrater ICC among the users for DSC and infarct volume was .86 (95% confidence interval [95% CI]: .78-.91) and .997 (95% CI: .995-.998). Intrarater ICC for the three users was .83 (95% CI: .69-.93), .84 (95% CI: .72-.91), and .80 (95% CI: .64-.89) for DSC, and .99 (95% CI: .987-.996), .991 (95% CI: .983-.995), and .996 (95% CI: .993-.998) for infarct volume. Manual segmentation of infarct volume on follow-up MRI-DWI shows excellent agreement and good spatial overlap with the reference standard, suggesting its usefulness for measuring infarct volume on 24- to 32-hour MRI-DWI.

Expiratory Muscles, Neglected No More.

Expiratory Muscles, Neglected No More.

Changes in Respiratory Muscle Thickness during Mechanical Ventilation: Focus on Expiratory Muscles.

The lateral abdominal wall muscles are recruited with active expiration, as may occur with high breathing effort, inspiratory muscle weakness, or pulmonary hyperinflation. The effects of critical illness and mechanical ventilation on these muscles are unknown. This study aimed to assess the reproducibility of expiratory muscle (i.e., lateral abdominal wall muscles and rectus abdominis muscle) ultrasound and the impact of tidal volume on expiratory muscle thickness, to evaluate changes in expiratory muscle thickness during mechanical ventilation, and to compare this to changes in diaphragm thickness. Two raters assessed the interrater and intrarater reproducibility of expiratory muscle ultrasound (n = 30) and the effect of delivered tidal volume on expiratory muscle thickness (n = 10). Changes in the thickness of the expiratory muscles and the diaphragm were assessed in 77 patients with at least two serial ultrasound measurements in the first week of mechanical ventilation. The reproducibility of the measurements was excellent (interrater intraclass correlation coefficient: 0.994 [95% CI, 0.987 to 0.997]; intrarater intraclass correlation coefficient: 0.992 [95% CI, 0.957 to 0.998]). Expiratory muscle thickness decreased by 3.0 ± 1.7% (mean ± SD) with tidal volumes of 481 ± 64 ml (P < 0.001). The thickness of the expiratory muscles remained stable in 51 of 77 (66%), decreased in 17 of 77 (22%), and increased in 9 of 77 (12%) patients. Reduced thickness resulted from loss of muscular tissue, whereas increased thickness mainly resulted from increased interparietal fasciae thickness. Changes in thickness of the expiratory muscles were not associated with changes in the thickness of the diaphragm (R2 = 0.013; P = 0.332). Thickness measurement of the expiratory muscles by ultrasound has excellent reproducibility. Changes in the thickness of the expiratory muscles occurred in 34% of patients and were unrelated to changes in diaphragm thickness. Increased expiratory muscle thickness resulted from increased thickness of the fasciae.

Footprint size matters: wider coronal greater tuberosity width is associated with increased rates of healing after rotator cuff repair.

BackgroundThe purpose of this study was to determine whether greater tuberosity morphology (1) could be measured reliably on magnetic resonance imaging (MRI), (2) differed between patients with rotator cuff tears (RCTs) compared with those without tears or glenohumeral osteoarthritis, or (3) differed between patients with rotator cuff repairs (RCR) who healed and those that did not.MethodsThis is a retrospective comparative study. (1) We measured greater tuberosity width (coronal and sagittal), lateral offset, and angle on MRI corrected into the plane of the humerus. To determine reliability, these measurements were made by two observers and intraclass correlation coefficients were calculated. (2) We compared these measurements between patients with a full-thickness RCT and patients aged >50 years without evidence of a RCT or glenohumeral osteoarthritis. (3) We then compared these measurements between those patients with healed RCRs and those with evidence of retear on MRI. In this portion, we only included patients with both a preoperative and postoperative MRI at least 1 year from RCR. Postoperative MRIs were obtained to assess healing rates, not because of concern for failure. Those without tendon defects were considered healed.Results(1) In a validation cohort of 50 patients with MRI, all inter-rater intraclass correlation coefficients were greater than 0.75. (2) There were no differences between our RCT group of 110 patients and our comparison group of 100 patients in tuberosity coronal width, sagittal width, or lateral offset. The RCT group had a significantly smaller greater tuberosity angle (63 ± 4° vs 65 ± 5°, P = .003). (3) In our group of 110 RCRs, postoperative MRI scans were obtained at a mean follow-up of 23.6 ± 15.7 months showing 84 (76%) patients had healed RCRs. Larger coronal tuberosity width was associated with healing (1.3 ± 0.2 vs 1.2 ± 0.2 cm, P = .032), as was smaller tear width (P < .001), and retraction (P < .001). When coronal width was dichotomized, there was a significantly higher healing rate with a width over 1.2 cm (85 vs 66%, P = .02). No other greater tuberosity morphological characteristics were associated with RCR or postoperative healing.ConclusionRCTs do not appear to be associated with greater tuberosity morphology. Postoperative rotator cuff healing based on MRI is 76%. Higher rates of healing occur with a wider coronal tuberosity width (ie, rotator cuff tendon footprint). Consideration could be given to widening the footprint intraoperatively in an effort to improve healing rates although this remains to be validated.

Intra- and inter-rater reliability of the Behaviour Mapping Schedule: A direct observational tool for classifying children’s play behaviour

Identifying and describing children’s play behaviours is an important component of evaluating child development. The Behaviour Mapping Schedule is a direct observational tool which aims to describe and quantify children’s play behaviours but is yet to undergo reliability testing. This study aimed to determine the intra- and inter-rater reliability of the Behaviour Mapping Schedule. Twelve children aged 3–5 years were each video recorded for one 20-minute playtime period at a purposively selected Community Children’s Centre in Adelaide, South Australia. The video recordings were coded independently by two raters against 23 behaviour codes. Intraclass correlation coefficients (ICCs) were calculated. Intra-rater ICCs for nearly 70% of the behaviour codes were considered ‘excellent’; likewise, for inter-rater ICCs on more than 50% of the behaviour codes. Overall, the Behaviour Mapping Schedule is a reliable tool for observing children’s play behaviour; however, additional training resources may be useful to further strengthen inter-rater reliability.

Callosal angle in idiopathic normal pressure hydrocephalus: small angular mal-rotations of the coronal plane affect measurement reliability.

The callosal angle (CA) is a useful biomarker in the diagnosis and management of idiopathic normal pressure hydrocephalus (NPH). Used incorrectly, CA measurements are variable, affecting its reliability as a clinical tool. Our objectives are to evaluate (i) reproducibility of established CA measurements between trained raters and (ii) impact of minor angular mal-rotations of the true coronal plane on CA measurements. CAs were measured by two independent raters on three-dimensional isovolumetric T1-weighted brain MRI of NPH patients and healthy controls using the established true coronal plane reformatted orthogonal to the plane containing the anterior-posterior commissural (AC-PC) line at the level of the posterior commissure. CA changes were subsequently evaluated when the coronal plane was mal-rotated by ± 5° and ± 10° in anterior-posterior and clockwise-anticlockwise directions. Inter-rater reliability of CA measurements was assessed using the intraclass correlation coefficient (ICC). On the true coronal plane, inter-rater ICC was excellent (0.973) for NPH patients and good (0.875) for controls. On mal-rotated coronal plane setups, ICC for CA was worse in controls (0.484-0.886) than NPH (0.879-0.981) groups and in clockwise-anticlockwise (0.484-0.956) than anterior-posterior (0.503-0.981) mal-rotations. CA changes secondary to mal-rotations from the true coronal plane were significant in NPH patients (P < 0.0001 to 0.0378) but not in controls (P > 0.1). This is the first demonstration of how small angular mal-rotations of the coronal plane used for CA measurement affect its value and inter-rater reliability, highlighting the importance of a standardized protocol when measuring the CA in NPH workup.

Body composition monitoring in children and adolescents: reproducibility and reference values

There is an increasing need for suitable tools to evaluate body composition in paediatrics. The Body Composition Monitor (BCM) shows promise as a method, but reference values in children are lacking. Twenty children were included and measured twice by 4 different raters to asses inter- and intra-rater reproducibility of the BCM. Reliability was assessed using the Bland-Altman method and by calculating intraclass correlation coefficients (ICCs). The intra-rater ICCs were high (≥ 0.97) for all parameters measured by BCM as were the inter-rater ICCs for all parameters (≥ 0.98) except for overhydration (0.76). Consequently, a study was set up in which BCM measurements were performed in 2058 healthy children aged 3–18.5 years. The age- and gender-specific percentile values and reference curves for body composition (BMI, waist circumference, fat mass and lean tissue mass) and fluid status (extracellular and intracellular water and total body water) relative to age were produced using the GAMLSS method for growth curves.Conclusion: A high reproducibility of BCM measurements was found for fat mass, lean tissue mass, extracellular water and total body water. Reference values for these BCM parameters were calculated in over 2000 children and adolescents aged 3 to 18 years.What is Known• The 4-compartment model is regarded as the ‘gold standard’ of body composition methods, but is inappropriate for regular follow-up or screening of large groups, because of associated limitations.• Body Composition Monitor® is an inexpensive field method that has the potential to be an adequate monitoring tool.What is New• Good reproducibility of BCM measurements in children provides evidence to use the device in longitudinal follow-up, multicentre and comparative studies.• Paediatric reference values relative to age and sex for the various compartments of the body are provided.

Reliability of Stereophotogrammetry for Area Measurement in the Periocular Region

Three-dimensional (3D) stereophotography area measurements are essential for describing morphology in the periocular region. However, its reliability has not yet been sufficiently validated. The objective of this study was to evaluate the reliability of 3D stereophotogrammetric area measurements in the periocular region. Forty healthy volunteers had five flat paper objects placed at each of the seven periocular positions including the endocanthion and the upper medial, upper middle, upper lateral, lower medial, lower middle, and the lower lateral eyelid. Two series of photographic images were captured twice by the same investigator. Each image of the first series was measured twice by the same rater, while images of both series were measured once by a second rater. Differences between these measurements were calculated, and the intrarater, interrater, and intramethod reliability was evaluated for intraclass correlation coefficients (ICCs), mean absolute differences (MADs), technical errors of measurements (TEMs), relative errors of measurements (REMs), and relative TEM (rTEM). Our results showed that 21.2% of all ICCs were considered as excellent, 45.5% were good, 27.3% were moderate, and 6.1% were poor. The interrater ICC for the endocanthion location was 0.4% on a low level. MAD values for all objects were less than 0.3 mm2, all TEM were less than 1 mm2, the REM and rTEM were less than 2% for all objects, showing high reliability. 3D stereophotogrammetry is a highly reliable system for periocular area measurements and may be used in the clinical routine for planning oculoplastic surgeries and for evaluating changes in periocular morphology.Level of Evidence IV This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266.

The reliability of radiographic measures of total ankle replacement position: an analysis from the OARS cohort.

There is no validated radiographic measurement to diagnose prosthetic complication(s) following total ankle replacements (TARs) although a number of angular and linear measurements, used to define the TAR position on postoperative radiographs, have been recommended to detect prosthetic loosening. The aim of this study was to test the intra- and interobserver reliability of these measurements. This is a prospective study embedded within a multicentre cohort study. Following sample size calculation, 62 patients were analysed. Six measurements were performed on the first postoperative anteroposterior and lateral ankle radiographs: angles α and β, and length "a" defined the craniocaudal position of the tibial component, while angle γ, and lengths "b" and "c" defined the angular position of the talar component. Measurements were recorded by three independent observers. Inter- and intraobserver reliability was assessed with intraclass correlation coefficient (ICC), Bland-Altman plots, and within-subject coefficients of variation (CV). The intrarater ICC was "almost perfect" (ICC 0.83-0.97) for all six measurements. The interrater ICC was "substantial" to "almost perfect" (ICC 0.69-0.93). The mean difference in intrarater angular measurements was ≤ 0.6° and ≤ 0.8mm for linear measurements, and ≤ 2.2° and ≤ 2.1mm for interrater measurements. Maximum CV for the interrater linear measurements (≤ 17.7%) more than doubled that of the angular measurements (≤ 8.0%). The maximum width of the 95% limits of agreement was 6.5° and 8.4mm for intrarater measures, and 8.9° and 10.6mm for interrater measurements. Angular measures are more reliable than linear measures and have potential in routine clinical practice for TAR position assessment.

Reliability of scapular upward rotation and anterior-posterior tilt measurements using a modified digital inclinometer in patients with subacromial impingement syndrome.

Reliable scapular upward rotation and anterior-posterior tilt data are required for patients with subacromial impingement syndrome (SIS). Only a few studies have explored the reliability of such measurements derived using a modified inclinometer. To determine the relative and absolute reliability of scapular upward rotation and anterior-posterior tilt measurements derived using a modified digital inclinometer in patients with SIS. Seventeen SIS patients were assessed twice within 1 week. We determined the relative and absolute measurement reliability by calculating the intraclass correlation coefficient (ICC), standard error of measurement (SEM), and minimal clinically important difference (MCID). Both intra- and interrater reliability were determined. The intra-rater reliability (both measurements) was high (0.72-0.88), and the interrater ICC was high to excellent (0.72-0.98). Clinically acceptable SEM and MCID values were obtained for scapular upward rotation (SEM: 4.28-9.33∘, MCID: 5.1-11.3∘) and anterior-posterior tilt (SEM: 3.72-7.55∘, MCID: 2.5-10.8∘). Measurements of scapular upward rotation and anterior-posterior tilt using a modified digital inclinometer reliably reveal scapular position and kinematics in patients with SIS.

Development and evaluation of a manual segmentation protocol for deep grey matter in multiple sclerosis: Towards accelerated semi-automated references

BackgroundDeep grey matter (dGM) structures, particularly the thalamus, are clinically relevant in multiple sclerosis (MS). However, segmentation of dGM in MS is challenging; labeled MS-specific reference sets are needed for objective evaluation and training of new methods. ObjectivesThis study aimed to (i) create a standardized protocol for manual delineations of dGM; (ii) evaluate the reliability of the protocol with multiple raters; and (iii) evaluate the accuracy of a fast-semi-automated segmentation approach (FASTSURF). MethodsA standardized manual segmentation protocol for caudate nucleus, putamen, and thalamus was created, and applied by three raters on multi-center 3D T1-weighted MRI scans of 23 MS patients and 12 controls. Intra- and inter-rater agreement was assessed through intra-class correlation coefficient (ICC); spatial overlap through Jaccard Index (JI) and generalized conformity index (CIgen). From sparse delineations, FASTSURF reconstructed full segmentations; accuracy was assessed both volumetrically and spatially. ResultsAll structures showed excellent agreement on expert manual outlines: intra-rater JI > 0.83; inter-rater ICC ≥ 0.76 and CIgen ≥ 0.74. FASTSURF reproduced manual references excellently, with ICC ≥ 0.97 and JI ≥ 0.92. ConclusionsThe manual dGM segmentation protocol showed excellent reproducibility within and between raters. Moreover, combined with FASTSURF a reliable reference set of dGM segmentations can be produced with lower workload.

Reliability of the infrared motion-time acquisition system for each motion segment in the timed up-and-go test.

[Purpose] This study aimed to investigate the reliability of an infrared motion-time acquisition system by measuring the time taken for five motion segments (sit-to-stand, forward gait, mid-turn, return gait, and turn-stand-to-sit) in the timed up-and-go test. [Participants and Methods] In total, 30 healthy adults (25.1 ± 4.6 years, 19 males and 11 females) were included in this study. Tester A and Tester B measured the time taken in the timed up-and-go test and its five motion segments with an infrared motion-time acquisition system, and two measurements were made by Tester A and one by Tester B. [Results] Intraclass correlation coefficients of the time taken for the five motion segments in the timed up-and-go test and the intra- and inter-rater intraclass correlation coefficients were greater than 0.9. [Conclusion] Infrared motion-time acquisition systems and its five motion segments are reliable and provide accurate measurements during the timed up-and-go test.

Translation, cross-cultural adaptation and validation of the Pulmonary Rehabilitation Adapted Index of Self-efficacy (PRAISE) scale for Brazilian patients with chronic obstructive pulmonary disease

Background: Patients with Chronic Obstructive Pulmonary Disease (COPD) present a progressive chronic airflow obstruction. Pulmonary Rehabilitation (PR) promotes the reversal of the extrapulmonary effects of the disease and improves the quality of life. Despite the physiological benefits, the major challenge of PR is to promote change in lifestyle. In this sense, it has been emphasized the study of psychological variables such as self-efficacy. Aim: To translate, cross-culturally adapt and validate the PRAISE scale for Brazilian COPD patients. Methods: The PRAISE scale was applied on the first day by two raters and 15-20 days later by one rater. Patients were assessed for self-efficacy with the General Self-Efficacy Scale (GSS) and the COPD Self-Efficacy Scale (CSES); functional limitation for activities of daily living with the London Chest Activity of Daily Living (LCADL) scale; anxiety and depression symptoms with the Hospital Anxiety and Depression Scale (HADS); quality of life with Saint George’s Respiratory Questionnaire (SGRQ); resilience with the Resilience Scale; and basic psychological needs with the Basic Psychological Needs in Exercise Scale (BPNES). The tests used were: Student’s t-test or Wilcoxon’s test (PRAISE score comparison); intraclass correlation coefficient (ICC), interrater reliability and test-retest and Cronbach’s alpha; and Spearman’s or Pearson’s correlation coefficient to assess validity. Results: The scale was pre-tested in 10 patients to evaluate translation accuracy and cross-cultural adaptation. Thirty-four patients with COPD took part (22 men; FEV1=42.2±15.7%pred). The interrater and test-retest ICCs were excellent (0.82 and 0.86, respectively), with no significant differences in test-retest reliability (p>0.05). Cronbach’s alpha interrater and testretest were 0.90 and 0.92, respectively (p<0.001). There were no floor and ceiling effects. The scale showed weak to moderate correlations with GSS, CSES, LCADL, HADS, SGRQ, Resilience Scale, and BPNES. Conclusions: The PRAISE scale proved to be valid and reliable for Brazilian patients with COPD.

Cardiovascular magnetic resonance reference values of mitral and tricuspid annular dimensions: the UK Biobank cohort

BackgroundMitral valve (MV) and tricuspid valve (TV) apparatus geometry are essential to define mechanisms and etiologies of regurgitation and to inform surgical or transcatheter interventions. Given the increasing use of cardiovascular magnetic resonance (CMR) for the evaluation of valvular heart disease, we aimed to establish CMR-derived age- and sex-specific reference values for mitral annular (MA) and tricuspid annular (TA) dimensions and tethering indices derived from truly healthy Caucasian adults.Methods5065 consecutive UK Biobank participants underwent CMR using cine balanced steady-state free precession imaging at 1.5 T. Participants with non-Caucasian ethnicity, prevalent cardiovascular disease and other conditions known to affect cardiac chamber size and function were excluded. Absolute and indexed reference ranges for MA and TA diameters and tethering indices were stratified by gender and age (45–54, 55–64, 65–74 years).ResultsOverall, 721 (14.2%) truly healthy participants aged 45–74 years (54% women) formed the reference cohort. Absolute MA and TA diameters, MV tenting length and MV tenting area, were significantly larger in men. Mean ± standard deviation (SD) end-diastolic and end-systolic MA diameters in the 3-chamber view (anteroposterior diameter) were 2.9 ± 0.4 cm (1.5 ± 0.2 cm/m2) and 3.3 ± 0.4 cm (1.7 ± 0.2 cm/m2) in men, and 2.6 ± 0.4 cm (1.6 ± 0.2 cm/m2) and 3.0 ± 0.4 cm (1.8 ± 0.2 cm/m2) in women, respectively. Mean ± SD end-diastolic and end-systolic TA diameters in the 4-chamber view were 3.2 ± 0.5 cm (1.6 ± 0.3 cm/m2) and 3.2 ± 0.5 cm (1.7 ± 0.3 cm/m2) in men, and 2.9 ± 0.4 cm (1.7 ± 0.2 cm/m2) and 2.8 ± 0.4 cm (1.7 ± 0.3 cm/m2) in women, respectively. With advancing age, end-diastolic TA diameter became larger and posterior MV leaflet angle smaller in both sexes. Reproducibility of measurements was good to excellent with an inter-rater intraclass correlation coefficient (ICC) between 0.92 and 0.98 and an intra-rater ICC between 0.90 and 0.97.ConclusionsWe described age- and sex-specific reference ranges of MA and TA dimensions and tethering indices in the largest validated healthy Caucasian population. Reference ranges presented in this study may help to improve the distinction between normal and pathological states, prompting the identification of subjects that may benefit from advanced cardiac imaging for annular sizing and planning of valvular interventions.